Professional Documents
Culture Documents
Mahapatra
UNIT - III
Role of pharmacist in the education and training program, internal and external training program,
Services to the nursing/clinics, Code of ethic for community pharmacy, and role of pharmacy in
the interdepartmental communication and community health education.
Education/Training/ Research
• Pharmacy professoin must serve needs of society and individual patient through the
world.
• In addition pharmacist are involved in direct patient care and are taking resposibility for
the resolution of drug therapy problems of individuals.
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Continuing professional development (CPD)
• Peck wt al (2000) indicated that there is no sharp division between CME and CPD
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Examples of SMART training goals
• The learner will use the ARROW system to ensure that a service request is logged in and
assigned to a technician the same day that the request is received.
• The learner will be able to recommend a theme and customize a menu that meets each
bridal party’s tastes and budget.
• The learner will follow the six-steps protocol to increase their sales by 8% this quarter.
Evaluation
• At this stage of the CPD cycle, questions are being asked such as:
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• Have I tested if what I have learnt can be applied to practice?
• Were there any problems with the reflection, planning or action parts of the CPD cycle?
• The pharmacist CPD record should comply with the good practice criteria published by
the RPSGB.
• Good practice criteria and useful advice to support the pharmacist in recording their CPD
are available on the RPSGB plan and record. Referring to these criteria can help to ensure
that the CPD portfolio is balanced.
It is important that a CPD record includes examples of learning that starts at action and learning
that starts at reflection.
Needed facilites
• We require 500 square feet area to setup training program classes in the hospital.
• Complete training session equipments like projector, laptop, highspeed internet with
computer
Patient Counseling
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Definition of patient counseling, steps involved in patient counseling, and special cases that
require the pharmacist.
Definition:
Patient counseling is defined as providing medication information orally or in written form to the
patients or their representatives on direction of use, advice on side effects. Precautions, storage,
diet and life style modification
1. Patient should recognize the importance of medication for his well being.
3. Patient’s understanding of strategies to deal with medication side effect and drug
interaction should be improved.
5. Patient becomes an informed, efficient and active participant in disease treatment and self
care management.
1. Introduction
3. Conclusion
Introduction
• Introduce yourself
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• Assess any actual and /or potential concern or problems of importance to the patient.
Conclusion
The amount and type of information provided to the patient will vary based on the patient’s
needs and practice setting. Ideally, the pharmacist counsels patients on all new and refill
prescriptions. If the pharmacist cannot counsel to this extent, it should be defined which patient
types or which medications pharmacists will routinely cousel patients. This will vary depending
on the pharmacy clientele and may include.
- Patients receiving more than a specified nummber of medications
- Patients known to have visual, hearing or literacy problems
- Paediatric patients
- Patients on anticoagulants
Appendix B provides additional types and groups of patients to cousel. Pharmacists should
counsel on all new prescription including transferred prescriptions.
Function of patient counselling
• Effective patients counselling aims to produce the following results.
• Better patients understanding of their illness and the role of medication in its treatment.
• Improved medication adherence
• More effective drug treatment.
• Reduced incidence of adverse effects and unnecessary healthcare costs.
• Improved quality of life for the patient.
• Better coping strategies to deal with medication related adverse effects.
• Improved professional rapport between the patient and pharmacist.
Patients who should always be counselled.
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- Confused patientsand their caregivers
- Patients who are sight or hearing impaired
- Patients with poor literacy
- Patients whose profile shows a change in medications or dosing.
- New patients or those receiving a medication for the first time(transfer prescription).
- Children and parents receiving medication
- Patients receiving medication with special storage requirements, complicated direction.
Patients who should be counseled at certain intervals
- Asthmatic patients
- Diabetic patients
- Patients taking 4 or more prescribed medications
- Patients who are mentally ill
- Patients using appliances
- Epileptic patients
- Patients with skin complaints
- Patients misusing drugs
- Patients who are terminally ill
Counselling area
The patient should be counseled in a semiprivate or private area away from other people and
distractions, depending on the medication(s).the patients should percieve the counseling area as
confidential, secure and conducive learning. This helps ensure both parties are focused on
discussion, and minimize interruption and distractions. It provides an oppurtunity for patients to
ask questions they may be hesitant to ask in public
The counselling process uses verbal and non verbal communicatino skills.
- Language
- Tone
- Volume
- Speed
- Proximity
- Facila expression
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Steps during patient counselling
Counselling is a two-way communication process and interaction between the patient and the
pharmacist is essential for ccounselling to be effective
Counselling content
The counselling content is cosidered to be the heart of the counselling session. During this step
the pharmacist explain to the patient about his or her medication and treatment regimen.
Lifestyle changes such as diet or exercise may also be discussed. Topics commonly covered
include.
Conclusion
At last we can say that patient counselling is a part and parcel of good medication. A good
counselling can provide a patient to take his medication.
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Drug and Poison information centre, Sources of drug information, Computerized services, and
storage and retrieval of information.
OUTLINE
Introduction
History
DIC
Information Sources
Answering of Queries
Drug Information Bulletin
Summary
References
Introduction
Growth of medical information at an alarming rate.
Vast data by FDA & from clinical investigation
Decision to chosing the best information
WHO developed DIC to promote rational use of drugs.
Drug Information
The provision of Written and/or Verbal information about Drugs and Drug therapy in response to
a request from other healthcare providing organizations, committees, patients and public
community.
Drug Information Center
Provides in-depth, unbiased source of crucial drug information to meet needs of the practicing
physicians, pharmacists and other health care professionals
Mission
To increase the community knowledge & awareness about drug & drug usage.
History
first DIC at University of Kentucky in 1960.
In US- 80% of the Hospitals have DIC
Indian scenario
WHO India country office+KSPC (Karnataka State Pharmacy Council)
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• SOPs for categorising enquiries & maintaining search pattern.
For optimal usage of drug information.
Staffing
• Pharmacy team: Pharmacist, Pharmacy technicians and Students
• Medical team : Toxicologist Clinical Pharmacologist
• Supporting team: People trained in library science with computer knowledge
Objectives of DIC
1. Promote evidence based practice
2. Meet the patient’s needs while providing pharmaceutical care.
3. Improve the patient adherence
1. Primary source
• Original information
• Scientific journal
• Thesis
• Proceedings of conferences
2. Secondary source:
• Database (pubmed, embase, scopus, toxline, national Library of Medicine gateway)
• Low drug information service
• Review articles.
3. Tertiary source:
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• Textbooks on drug or disease topics
• Pharmacopeias- IP, BP, USP, BNF etc.,
• Encyclopedia
• Dictionaries
• Guides
Other sources
• Public and hospital about the AE of any drug.
• Local drug lists
• National formulation, Hospital formularies
• Internet
• Phone calls to manufacturers, government and non-government organization & to other
DIC
Services offered:
• Information about drugs
• Poison management information
• Patient education service
• Assistance on drug usage in patients.
• Professional assistance for investigations in drug usage
• Drug related information to hospital staff.
• Reporting and investigating ADR
Prescribed medication order- interpretation and legal requirements, and Communication skills-
communication with prescribers and patients.
Objectives
Communication
Guide to patient counseling
Interpersonal communication
Listening techniques for the patient interview process
Nonverbal aspects of communication
Barriers to effective communication
Communication with special patient & children
Ethical principles.
Communication
It is the process in which messages are generated and sent by one person and received and
translated by another person.
In fact, a message is successful only when both the sender and the receiver perceive it in the
same way.
However, the meaning generated by the receiver can be different from the senders’s intended
message.
• Relationship • Barriers/Noise
• Feeling • Feedback
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Rights and Responsibilities
Be listened to
Say “No” to something we don’t want to do or don’t believe in without feeling guilty
Pharmaceutical care: “ the responsibility provision of drug therapy for the purpose of achieving
definite outcomes that improve a patient’s quality of life” (Hepler and Strand 1990)
The communication process between health professionals and patients serves two primary
function.
4. Build a therapeutic alliance with patient to meet mutually understood goals of therapy.
The health care professional should encourage patients to share experience with therapy because
- They may not reveal information to you unless you initiate a dialogue
- Purpose of medication
- Goals of therapy
Advantages : an effective communication process can optimize the chance that patients will
make informed decision use medications properly and meet therapeutic goals
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3. Use a “teach back” or “show me” technique to check understanding.
Together , these strategies and other will help ensure the environment is patient-friendly and
shame-free for ALL patients.
• Limit information
• Develop short explaination for common medical condition and side effects
• I want to make sure I explained everything clearly. If you were trying to explain to
explain to your husband how to take this medicines, what would you say?
• Lets review the main side effects of this new medicines. What are the 2 things that I
asked you to watch out for?
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• Show me how you would use this inhaler.
• Don’t say:
• Instead say:
Learn as much as you can about the patient’s background, including beliefs about
taking medications.
View diversity as an opportunity with a little patience and the right attitude, you will
be amazed at the opportunity that crop up to help one another.
Do not condescend. Patronizing behavior is not appreciated and is recognized as such
in any culture.
Talk about your differences. Misunderstanding will often take root when people from
differing backgrounds do not talk to one another.
Be willing to talk openly and with a constructive attitude.
Determine the patient’s ability to learn specific information in order to guide you in your
presentation of the material. Reading ability, language proficiency and vision or hearing
impairment all would influence the techniques you use in interviewing and counseling a
patient.
Maintain objectivity by not allowing the patient’s attitude, belief or prejudice to influence
your thinking.
Be aware of the patient’s nonverbal messages.
Depending on your relationship with patient, move on from less personal to more
personal topics. This may remove some of the patient’s initial defensiveness.
Note taking should be as a brief as possible.
Avoid making recommendations during the information-gathering phases of the
interview. Such recommendations prevent the patient from giving you all the needed
information and interfere with your ability to grasp the big picture of patient need.
Similarly, do not jump into conclusions or rapid solutions without hearing all of the facts.
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Do not shift from one subject to another until each subject has been followed through.
Guide the interview using a combination of open ended and closed ended questions.
Similarly, keep your goals clearly in mind, but do not let them dominate how you go
about the interview.
For example, a pharmacist seeing a patient for the first time might say:
Hello, Mr. Pearson. I’m Jane Bradley, the pharmacist (the introduction)
Since you are new to our pharmacy, I would like to ask you a few quick questions about the
medications you are now taking (subject).
This will take about 5-10 minutes (the amount of time needed) and will allow me to create a drug
profile so that I can keep track of all the medications you are taking. This will help us identify
potential problems with new medications that might be prescribed for you(the purpose/outcome).
Alcohol use
2. Ask whether the situation has ever, at any time, occurred and then ask about the current
situation.
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Difference between open vs closed-ended Qs.
- Open ended question: How did you take your doses last month?
Closed ended
Open ended
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Probing
Probing: is the use of questions to elicit needed information from patients or to help clarify their
problems or concerns.
Avoid “why” type question; For example, people might become defensive if asked
Instead of
Personal barrier include low self-confidence, shyness, dysfunctional internal monologue, lack of
objectivity, culture difference, discomfort in sensitive situation and conflicting values to
healthcare practice.
Administrative barriers such as management may view the lack of money compensated for
communication as a reason not communicate. More money is made by prescribing medication
not caring for patients.
Time barriers are interlinked with administration barriers because management is responsible for
staffing levels as well as allocation of work duties. Times limits are very common when it comes
to pharmacist and patients. Time restraints are often excuses not to counsel, though it often does
not take very long.
Listening:
Probing: is the use of questions to elicit needed information from patient or to help clarify their
problems or concerns.
Perception is how a message is perceived by a patient. The patient may view the doctor as only
being interested in diseases, drugs and money, not people. If the patient views the doctor as
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being incompetent or uncaring, he/she is less likely to trust the doctor’s advice. Perception is an
example of a psychological barrier.
Negative attitude from doctors or pharmacist are usually caused by a lack of confidence and low-
esteem. Communication is far from ideal all the time and doctors or pharmacist should strive to
improve their skills through practice.
Many doctors believe that it is not their job to counsel their patients, but it is. Negative attitude is
an example of psychological barrier.
Fogging; involves acknowledging the ruth or possible truth in what people tell you about
yourself while ignoring completely any judgments they might have implied by what they
said.
Delaying a response
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Talk in private
Listening well
Listening well involves understanding both the content of the information being provided and the
feeling being conveyed
1. Summarizing
2. Paraphrasing
Nonverbal expressions
Distracting factors
In addition to communication barriers, some communication habits can interfere with your
ability to listen well.
• Multitasking : to do two things at once (it evident to patients that they don’t have your
full attention)
• Planning ahead to what you will say next: Planning next point (interruption?)
• Jumping to conclusions before patients have completed their messages (only hearing
parts of messages).
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• Judging the person or the message as it is being conveyed
• Faking interest
The elderly
In certain individuals, the aging process affects the learning process, but not the ability to learn.
Some older adults learn at a slower rate than younger persons.
The elderly might also have problems such as poor vision, speech or hearing.
Therefore, it is very important to set reasonable short-terms goals and break down learning tasks
into smaller components.
It is also important to encourage feedback as to whether they understand the intended message.
1. Emphasizing key points. “this is very important” helps the remember what follows.
2. Give reason for key advice, eg., with an antibiotic prescription, tell why it is necessary to
continue medication use even though symptoms have disappeared.
3. Give definite concrete, explicit instruction. Any information that patient can mentally
picture is more easily remembered. Use visual aids, photographs or demonstrations.
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5. Supplement and reinforce spoken words with written instruction.
Are usually intimidating to work with because people do not want to say the “wrong” things
that would upset them.
Before interacting with them, be aware of your own feelings about death and about
interacting with terminally ill patients.
Simply being honest with them can improve their interaction with them. It will also open
them upto voice out their concerns as well.
Many terminally ill patients know that they can make others feel uncomfortable. You should
not avoid talking to them unless you sense that they do not want to talk.
Not interacting with them only contributes further to isolation and may re affirm that talking
about death is uncomfortable
Open-ended questions would be more effective as they can be used to determine the patient’s
cognitive abilities.
Ethical considerations include whether they require consent from the patient for treatment.
Mentally ill patients might not always understanding their treatment or medication purposes.
- Ask open ended questions rather than questions requiring only a yes or no response.
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- Children want to know. Healthcare professionals should communicate directly with
children about medicines and treatment.
Ethical principles
Beneficence is the principle that health professionals should act in the best interest of the
patient.
Autonomy is the principle that establishes patient rights to self-determination to choose what
will be done to them.
Honesty principles states that patients have the right to the truth about their medical
condition, the course of disease, the treatment recommended and the alternative treatments
available.
Informed consent has occurred and treatment can be implemented if all relevant information
is provided, if the patients understand the information and if consent is given freely without
coercion.
Organizations, functions, Policies of the pharmacy and therapeutic committee including drugs
into formulary, inpatient and outpatient prescription, automatic stop order, and emergency drug
list preparation.
Hospital committees and teams plays an important role in management and decision making in
hospital. While, hospitals are organized into departments with each department, for something as
complex as healthcare, there are many issues which cut across the responsibilities of more than
one department.
These issues require people in different roles and with different expertise, to collectively take
appropriate decisions and actions. Committees and teams are formed for this purpose and
depending upon the type of issues to be dealt with different committees and teams are formed.
NABH standards indicates several types of committees and teams to be functioning in a hospital
and this post lists and explains the same.
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One of the method or mode of ensuring the proper rationality in the use of drugs is that the
hospital organize and constitute, The pharmacy and Therapeutic Committee.
Definition:
The pharmacy and therapeutic committee is a policy framing and recommending body to
the medical staff and the administration of hospital on maters related to therapeutic use of
drugs.
1. Advisory
2. Educational
Advisory:
The committee serves in an advisory capacity to medical staff and hospital administration
in all matters pertaining to the use of drugs including the investigational drugs.
The committee advises the pharmacy in implementation of effective drug distribution and
control procedure.
Educational:
The committee evaluates the problems related to the distribution and administration of
medication including medication incident.
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The committee develops and compiles a formulary of drugs and prescriptions of
formulations accepted for use in the hospitals.
The committee should minimize duplication of the same drug, drug safety and cost.
It establishes or plans suitable educational schemes for the hospital’s professional staff on
the matters related to the use of drugs.
This function is assigned to or taken up by the PTC and it should be continuous scheme of
exerting vigilance.
Composition of PTC:
2. A pharmacist
An hospital administrator with his or her designated an ex-officio member of the committee. One
of the physicians may be appointed as the chairman of PTC. The pharmacist funstions usually as
the secretary and therefore he is designated as the secretary of the committee.
Operation of PTC:
• This committee should meet regularly at least 6 times in the year and also as and when
necessary.
• The committee can invite its meetings persons within or outside the hospital who can
contribute specialized or unique knowledge, skill and judgements.
• The agenda and the supplementary materials should be prepared by the secretary and
furnished to the committee members well in advance so that the members can study them
properly before the meeting.
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A typical agenda may consist of the following categories in general:
2. Reiew of the contents of the hospital formulary for purpose of bringing it up to date and
deleting of products not considered necessary of use,
3. Information regarding new drugs which may have become commercially available.
4. Review of side effects, adverse drug reactions, toxic effects, drug interaction of drugs
reported by various units of the hospitals and brought to notice of the committee by DIC.
9. Vote of thanks.
10. The minutes of all meeting hold should be prepared by the secretary and a permanent
records of these minutes should maintained in the hospital.
• Drug safety includes responsibility from dispensing of drugs to drug administration and
then to observe possible adverse effects. PTC can play a major role in ensuring the drug –
safety.
• Following guidelines may sub serve the committee in ascertaining the adequate safety
factor of the hospital pharmacy.
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7. Form policy –research drugs.
8. Drug formulary
Every case of adverse drug reaction must be first reported by the attending physician to the
chairman of the PTC or clinical pharmacologist.
The attending physician should complete the adverse Drug Reaction report form as
illustration above on any patient having adverse reaction.
The medical record room will upon the patients discharge remove this report from the
medical record and forward it to the chairman who in turn periodically forward essential data
to the central committee on adverse reaction formed by the state government or the drug
control authorities of the state government and the drugs controller or consultation with the
bodies of expert such as Drug Technical Advisory Board.
All Drug orders for narcotics, sedatives, hypnotics, anticoagulants and antibiotic shall be
automatically discontinued after 48hrs unless the order indicates an exact number of
doses to be administration or the attending physician reorder the medication.
All orders for narcotics, sedatives and hypnotics must be rewritten every 24 hrs.
In india at present, this kind of system of iisuing “ASODD” is not practicied except for
hospitals like Christian Medical Hospital Vellore or Jaslok hospitals Mumbai Excort
group, Mayo Hospitals etc.
Since time factor is of very great urgency to most true emergency situation, it is
absolutely necessary for the PTC of a hospital to get prepared boxes containing
emergency drugs which should be always available readily for use at the bed side.
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List of such drugs and their supplies should be complied by the committee and it should
find their place in emergency kits.
I. Syringes of various range two each of 1ml i.e. tuberculin or insulin, 2 ml syringes and 5
ml syringes and one each of 10 ml and 20ml syringes.
IV. Torniquets
V. Airway equipment
These may selected in consultation with the physician but the following list is illustrated only.
I. Aminophylline 0.25g/ml
X. Hydrocortisone 100mg
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XV. Neostigmine methyl sulphate 0.25mg/ml
XVIII. Pentazocine
I. Resuscitation cartts
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V. Dextran and tubing
NB:Each hospital may modify this lst by adding or deleting items as found necessary.
The drugs purchased by hospital may be defective in quality, it is for the committee to get
information about the defective drug product and to inform it first to the manufacturer for
appropriate action.
1. Medication being taken at the time of admission , during admission, home remedies
(OTC) drugs.
1. To help inproved drug prescribing practices by promoting the safe and rational use of the
drugs.
PTC is the backbone of the hospital pharmacy and its services and therefore, it should properly
organized.
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